About the I-PASS Institute

Background

Communication and handoff failures are both common and hazardous, and have been identified by the
Joint Commission and the Department of Defense as a contributing cause in approximately two out of every three sentinel events – serious, often fatal, preventable adverse events in hospitals. Recognizing the role of handoff failures in medical errors, the Accreditation Council for Graduate Medical Education (ACGME) now requires all training programs to teach resident physicians handoff skills and to monitor the quality of handoffs. Despite these requirements and concerns, effective handoff curricula and methods to ensure that trainees acquire handoffs skills are lacking. To address this gap, we developed the I-PASS Handoff Bundle, an evidence-based, standardized approach to teaching, evaluating, and improving handoffs.

The I-PASS Study

Informed by a single institution pilot study (Starmer et al, JAMA 2013), the I-PASS Study was launched, an eleven-center handoff intervention study (Sectish et al, Pediatrics 2011). To develop the I-PASS Handoff Bundle for use in the multi-site study, we applied a rigorous approach to curriculum development (Starmer et al, Academic Medicine 2013). The I-PASS Handoff Bundle, includes a comprehensive suite of educational materials with six major complementary components. A cornerstone of the curriculum is I-PASS (Starmer et al, Pediatrics 2012), a mnemonic for the key elements of the handoff process: I: Illness severity; P: Patient summary; A: Action items; S: Situation awareness and contingency planning; S: Synthesis by receiver. The I-PASS mnemonic is integrated throughout each curricular module as a framework and way of standardizing the handoff process.

Across nine data collection sites, we conducted a prospective intervention study, the I-PASS Study, to assess the relationship of implementing the I-PASS Handoff Bundle to medical error rates (Starmer et al, NEJM 2014). Following implementation of the I-PASS Handoff Bundle across 10,740 patient admissions, we found that medical errors decreased by 23% (24.5 vs 18.8 per 100 admissions, p<0.001) and preventable adverse events—medical errors resulting in harm to patients— decreased by 30% (4.7 vs 3.3 per 100 admissions, p<0.001). As evidence of successful implementation, significant increases across all sites were observed in inclusion of key information in written handoff documents (improvements in 9 of 9 pre-specified key elements) and in verbal communications during handoffs (5 of 5 key elements) (p<0.001 for all 14 comparisons). There were no significant changes in the duration of oral handoff per patient (2.4 vs. 2.5 minutes, p=0.55) or resident workflow, including patient-family contact or computer time.

I-PASS Mentored Implementation Program

Given the ubiquity of handoff problems in hospitals and the evidence that implementation of the I-PASS Handoff Bundle was associated in a substantial reduction in medical errors and improvement in patient safety, further dissemination and implementation of I-PASS has the potential to have an enormous impact on patient safety. With this in mind, we partnered with the Society of Hospital Medicine (SHM) and the Pediatric Research in Inpatient Settings (PRIS) network to facilitate the dissemination of the I-PASS Handoff Program to 16 pediatric and 16 adult teaching hospitals. To accomplish this goal, we will employ SHM’s award-winning “Mentored Implementation” methodology, a proven vehicle for carrying out a wide range of multi-center quality improvement initiatives. Success will be measured by penetrance of the program and adherence to proven handoff processes, as well as resident and faculty physician handoff experience.

Each site will be paired with a team of mentors from the I-PASS Institute who are experienced in I-PASS Handoff techniques as well as quality improvement and program implementation strategies generally. The intent of the I-PASS Mentored Implementation Project is to improve handoff processes and decrease rates of communication failures at each participating site using the I-PASS Handoff Bundle, which has been demonstrated to reduce adverse events through the The I-PASS Study.

A document with answers to Frequently Asked Questions about the I-PASS Mentored Implementation Program is available. The application cycle for the I-PASS Mentored Implementation Program is currently closed. For additional questions about the I-PASS Mentored Implementation Program, email
SHM.IPASS@childrens.harvard.edu

Patient and Family Centered I-PASS Research Study

While adoption and dissemination of the I-PASS Handoff Bundle has been extensive so far, the use of I-PASS has been limited to improving intra-disciplinary handoffs (e.g. physician to physician handoff). I-PASS methods have not been extensively tested in inter-professional and patients/family communication. Concurrently, multi-disciplinary family-centered rounds have begun to replace traditional, physician-only rounds in many hospitals. The manner in which physicians, nurses, and families interact and communicate on family-centered rounds is not well structured and communication methods do not typically take into account the preferences of diverse families and patients.

With the support of funding through PCORI, we plan to address this issue by incorporating I-PASS into family-centered rounds and communication processes and measuring the effects on patient safety, patient/family experience, and care processes. Doing so will bring together two transformative communication interventions: 1) the I-PASS Handoff Bundle which that has been demonstrated to decrease medical errors and written and verbal miscommunications; and 2) an initiative to more effectively incorporate patients and families into healthcare communication and decision making.

We plan to adapt and expand key aspects of the I-PASS Handoff Bundle for use in family-centric communications, under the guidance of a family advisory council. The elements of the intervention will address: a) training for residents and faculty in how to better communicate and integrate family preferences into decision making; b) integration of the I-PASS handoff structure into morning rounds, in a manner that engages physicians, nurses, and families; and c) use of written / computerized tools for families to facilitate communication. After gathering baseline data, we will prospectively measure the ability of the intervention to decrease rates of serious medical errors, improve shared understanding of the care plan among providers and families, and improve resident-physician and nurse experience.

Participating sites in the Patient and Family Centered I-PASS Study have already been selected and include six of the original I-PASS Study institutions. For more information about this research study contact
ipass.institute@childrens.harvard.edu.

Members, Partner Institutions and Organizations

The I-PASS Institute includes over 50 faculty from across North America with expertise in health services research, faculty development, medical simulation, curriculum development, and change management. The Pediatric Research in Inpatient Settings (PRIS) Network and the Initiative for Innovation in Pediatrics Education (IIPE) contribute to the management and oversight of the I-PASS Study. Some content in the I-PASS Handoff Curriculum includes materials adapted from TeamSTEPPS®, an evidence-based teamwork curriculum developed by the Agency for Healthcare Research and Quality and the Department of Defense Patient Safety Program.

Supporting groups:

The following groups contributed to the development, management, and/or oversight of the I-PASS Institute:

Copyright

The I-PASS Study is supported by Grant Number R18AE000029 from the U.S. Department of Health and Human Services. The content is solely the responsibility of the authors and does not necessarily represent the official views of the federal government.